Civil Air Patrol New Membership Information Request Form Note: If you are interested in joining CAP as an Aerospace Education Member (please do not fill out this form) click here instead.

*Denotes Required Field
	Mr.    Mrs.    Ms.
*First Name:	MI: *Last Name:
*Address:
*City:	*State: AA AE AK AL AP AR AZ CA CO CT DC DE FL GA HI IA ID IL IN KS KY LA MA MD ME MI MN MO MS MT NC ND NE NH NJ NM NV NY OH OK OR PA PR RI SC SD TN TX UT VA VT WA WI WV WY   *Zip Code:
*Email Address:
*Phone:	(Numbers only)
*Age:	10-18 19-20 21-25 26-30 31-35 36-40 40-45 Over 45
Parent's Name:	(Only required if you are under 18 years of age)
Date Of Birth:	Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec   1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31   1991 1992 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010  (Only required if you are under 18 years of age)

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Areas I am interested in: (use Ctrl key to select multiples)	All CAP Missions Aerospace Education Cadet Program Communications Disaster Relief Flight Operations Ground SAR
How did you hear about CAP?
Referred by CAP Member:
*Type "YES" to confirm that you have read and agree to the terms and conditions of entry to Pease ANGB: